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Dive into the research topics where Marjolaine Georges is active.

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Featured researches published by Marjolaine Georges.


European Respiratory Journal | 2009

Evaluating noninvasive ventilation using a monitoring system coupled to a ventilator: a bench-to-bedside study

Claudio Rabec; Marjolaine Georges; Ntumba Kabeya; Nicolas Baudouin; François Massin; O. Reybet-Degat; Philippe Camus

Empirically determined noninvasive ventilation (NIV) settings may not achieve optimal ventilatory support. Some ventilators include monitoring modules to assess ventilatory quality. We conducted a bench-to-bedside study to assess the ventilatory quality of the VPAPTMIII-ResLinkTM (ResMed, North Ryde, Australia). We tested the accuracy of minute ventilation (MV) and leak calculations given by VPAPTMIII-ResLinkTM compared to those measured by a bench model at varied leak levels and ventilator settings. We systematically assessed NIV efficacy using this system from 2003 to 2006. Ventilation was considered inadequate if leak (>24 L·min−1), continuous desaturation (>30% of the trace) or desaturation dips (>3%) were present. On the bench test, both methods were highly correlated (r = 0.947, p>0.0001 and r = 0.959, p<0.0001 for leak and MV, respectively). We performed 222 assessments in 169 patients (aged 66.42±16 yrs, 100 males). Abnormalities were detected on 147 (66%) out of 222 occasions. Leak was the most common abnormality (34.2%) followed by desaturation dips (23.8%). The most effective therapeutic solutions were a chin strap if leak was detected (61.2%) and expiratory positive airway pressure increase for desaturation dips (59.5%). In 15.7% of cases, when abnormalities persisted, a polygraphy was performed. The systematic use of this device enables NIV to be optimised, limiting the indication of sleep studies to complex cases.


European Respiratory Journal | 2015

Haemoptysis in adults: a 5-year study using the French nationwide hospital administrative database

Caroline Abdulmalak; Jonathan Cottenet; Marjolaine Georges; Philippe Camus; Philippe Bonniaud; Catherine Quantin

Haemoptysis is a serious symptom with various aetiologies. Our aim was to define the aetiologies, outcomes and associations with lung cancer in the entire population of a high-income country. This retrospective multicentre study was based on the French nationwide hospital medical information database collected over 5 years (2008–2012). We analysed haemoptysis incidence, aetiologies, geographical and seasonal distribution and mortality. We studied recurrence, association with lung cancer and mortality in a 3-year follow-up analysis. Each year, ∼15 000 adult patients (mean age 62 years, male/female ratio 2/1) were admitted for haemoptysis or had haemoptysis as a complication of their hospital stay, representing 0.2% of all hospitalised patients. Haemoptysis was cryptogenic in 50% of cases. The main aetiologies were respiratory infections (22%), lung cancer (17.4%), bronchiectasis (6.8%), pulmonary oedema (4.2%), anticoagulants (3.5%), tuberculosis (2.7%), pulmonary embolism (2.6%) and aspergillosis (1.1%). Among incident cases, the 3-year recurrence rate was 16.3%. Of the initial cryptogenic haemoptysis patients, 4% were diagnosed with lung cancer within 3 years. Mortality rates during the first stay and at 1 and 3 years were 9.2%, 21.6% and 27%, respectively. This is the first epidemiological study analysing haemoptysis and its outcomes in an entire population. Haemoptysis is a life-threatening symptom unveiling potentially life-threatening underlying conditions. Haemoptysis is ominous: there is often no clear aetiology and 4% of patients develop lung cancer during follow-up http://ow.ly/KqJDG


European Respiratory Journal | 2016

Cortical drive to breathe in amyotrophic lateral sclerosis: a dyspnoea-worsening defence?

Marjolaine Georges; Elise Moraviec; Mathieu Raux; Jésus Gonzalez-Bermejo; Pierre-François Pradat; Thomas Similowski; Capucine Morélot-Panzini

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease causing diaphragm weakness that can be partially compensated by inspiratory neck muscle recruitment. This disappears during sleep, which is compatible with a cortical contribution to the drive to breathe. We hypothesised that ALS patients with respiratory failure exhibit respiratory-related cortical activity, relieved by noninvasive ventilation (NIV) and related to dyspnoea. We studied 14 ALS patients with respiratory failure. Electroencephalographic recordings (EEGs) and electromyographic recordings of inspiratory neck muscles were performed during spontaneous breathing and NIV. Dyspnoea was evaluated using the Multidimensional Dyspnea Profile. Eight patients exhibited slow EEG negativities preceding inspiration (pre-inspiratory potentials) during spontaneous breathing. Pre-inspiratory potentials were attenuated during NIV (p=0.04). Patients without pre-inspiratory potentials presented more advanced forms of ALS and more severe respiratory impairment, but less severe dyspnoea. Patients with pre-inspiratory potentials had stronger inspiratory neck muscle activation and more severe dyspnoea during spontaneous breathing. ALS-related diaphragm weakness can engage cortical resources to augment the neural drive to breathe. This might reflect a compensatory mechanism, with the intensity of dyspnoea a negative consequence. Disease progression and the corresponding neural loss could abolish this phenomenon. A putative cognitive cost should be investigated. Awake ALS patients with respiratory failure mobilise cortical resources to keep breathing; dyspnoea is the ransom http://ow.ly/XGhaf


Sleep Medicine | 2011

Effectiveness of Adaptive Servo Ventilation in the treatment of hypocapnic central sleep apnea of various etiologies

Claudio Carnevale; Marjolaine Georges; Claudio Rabec; Renaud Tamisier; Patrick Levy; Jean-Louis Pépin

BACKGROUND Central sleep apnea (CSA) occurs in clinical situations that induce hypocapnia and respiratory instability during sleep. This is true, not only in heart failure patients, but also in patients suffering from neurological diseases and idiopathic CSA. Adaptive Servo Ventilation (ASV) is frequently prescribed in France for the treatment of CSA, but only a few studies have evaluated ASV treatment with regards to long term effectiveness and compliance. METHODS Retrospective chart review in two French centers of the outcome of 74 CSA patients treated by ASV with a mean follow up on ASV of 36±18 months. RESULTS Thirty-three of the 74 patients suffered from CSA related to heart failure (HF), whereas the 41 others exhibited CSA mainly associated with neurological disorders or idiopathic CSA. Mean ASV compliance was 5.2±2.6 and 5.9±2.9h per night in cardiac failure and non-cardiac failure patients, respectively. All patients significantly improved their apnea+hypopnea index (from 47.4±19.8 to 6.9±9.3/h [p<0.001]) and mean nocturnal SaO(2) (from 92.1±2.6% to 93.6±3.2% [p<0.001]). The Epworth sleepiness scale score was reduced from 10.2±5.2 to 6.5±3.9 (p<0.01) in compliant patients but not in non-compliant patients (less than 3h per night). Moreover, compliant cardiac failure patients demonstrated a significant improvement in their NYHA score [p<0.05]. Lastly, ASV significantly reduced chronic hyperventilation as assessed by blood gases. CONCLUSION Our findings suggest that ASV is well tolerated and effective for most patients with hypocapnic central sleep apnea and chronic hyperventilation.


Journal of Neurology, Neurosurgery, and Psychiatry | 2016

Reduced survival in patients with ALS with upper airway obstructive events on non-invasive ventilation

Marjolaine Georges; Valérie Attali; Jean Louis Golmard; Capucine Morélot-Panzini; Lise Crevier-Buchman; Jean-Marc Collet; Anne Tintignac; Elise Morawiec; Valery Trosini-Désert; François Salachas; Thomas Similowski; Jésus Gonzalez-Bermejo

Introduction Non-invasive ventilation (NIV) is part of standard care in amyotrophic lateral sclerosis (ALS). Intolerance or unavailability of NIV, as well as the quality of correction of nocturnal hypoventilation, has a direct impact on prognosis. Objectives We describe the importance of NIV failure due to upper airway obstructive events, the clinical characteristics, as well as their impact on the prognosis of ALS. Methods Retrospective analysis of the data of 190 patients with ALS and NIV in a single centre for the period 2011–2014. 179 patients tolerating NIV for more than 4 h per night without leaks were analysed. Results Among the 179 patients, after correction of leaks, 73 remained inadequately ventilated at night (defined as more than 5% of the night spent at <90% of SpO2), as a result of obstructive events in 67% of cases (n=48). Patients who remained inadequately ventilated after optimal adjustment of ventilator settings presented with shorter survival than adequately ventilated patients. Unexpectedly, patients with upper airway obstructive events without nocturnal desaturation and in whom no adjustment of treatment was therefore performed also presented with shorter survival. On initiation of NIV, no difference was demonstrated between patients with and without upper airway obstructive events. In all patients, upper airway obstruction was concomitant with reduction of ventilatory drive. Conclusions This study shows that upper airway obstruction during NIV occurs in patients with ALS and is associated with poorer prognosis. Such events should be identified as they can be corrected by adjusting ventilator settings.


Respiratory Medicine | 2013

Pulse wave amplitude reduction: a surrogate marker of micro-arousals associated with respiratory events occurring under non-invasive ventilation?

Dan Adler; Pierre-Olivier Bridevaux; Olivier Contal; Marjolaine Georges; Elise Dupuis-Lozeron; Elisabeth Claudel; Jean-Louis Pépin; Jean Paul Janssens

INTRODUCTION Respiratory events occurring under non-invasive ventilation (NIV) may produce sleep fragmentation. Alternatives to polysomnography (PSG) should be validated for providing simple monitoring tools for patients treated at home with NIV. OBJECTIVES To study the value of pulse wave amplitude (PWA) reduction as a surrogate marker of cortical micro-arousals associated with respiratory events occurring during NIV. METHODS 27 PSG tracings under NIV recorded in 9 stable patients with Obesity Hypoventilation Syndrome (OHS), under 3 different ventilator modes (no back-up rate, low or high back-up rate) were analyzed. For all respiratory events (obstructive, central, or mixed event), the association with EEG-micro-arousals, PWA reduction of more than 30% and the presence of associated SpO2 desaturation ≥ 4% was recorded. RESULTS 2474 respiratory events during NREM sleep were analyzed. 73.6% were associated with an EEG-MA, 91.4% with a ≥ 4% decrease in SpO2, and 74.9% with a significant PWA reduction. Sensitivity of PWA for the detection of an EEG-micro-arousal related to a respiratory event was 89.1% [95%CI: 76.7-95.3]. Positive predictive value (PPV) was 87.0% [95%CI: 75.0-94.0]. Sensitivity of PWA was highest in the S mode, compared to both other S/T modes, p = <0.001. Sensitivity of PWA was also higher for central and mixed events, compared to obstructive respiratory events, p = <0.05. CONCLUSIONS PWA reduction is a sensitive marker with a high PPV for the detection of EEG-MA associated with respiratory events during NREM sleep in stable OHS patients treated by NIV. In this situation, PWA could be used to improve scoring of hypopneas and allow an appropriate assessment of sleep fragmentation related to respiratory events.


Respirology | 2016

Usefulness of transcutaneous PCO2 to assess nocturnal hypoventilation in restrictive lung disorders.

Marjolaine Georges; Danièle Nguyen-Baranoff; Lucie Griffon; Clément Foignot; P. Bonniaud; P. Camus; Jean-Louis Pepin; Claudio Rabec

Nocturnal hypoventilation is now an accepted indication for the initiation of non‐invasive ventilation. Nocturnal hypoventilation may be an under diagnosed condition in chronic respiratory failure. The most appropriate strategy to identify sleep hypoventilation is not yet clearly defined. In clinical practice, it is indirectly assessed using nocturnal pulse oximetry (NPO) and morning arterial blood gases (mABG). Even though continuous transcutaneous carbon dioxide partial pressure (TcPCO2) monitoring is theoretically superior to NPO plus mABG, it is not routinely used. We aimed to prospectively compare NPO plus mABG with nocturnal TcPCO2 for the detection of alveolar hypoventilation in a cohort of patients with chronic restrictive respiratory dysfunction.


Respiratory Care | 2015

Reliability of Apnea-Hypopnea Index Measured by a Home Bi-Level Pressure Support Ventilator Versus a Polysomnographic Assessment

Marjolaine Georges; Dan Adler; Olivier Contal; Fabrice Espa; Stephan Perrig; Jean-Louis Pépin; Jean-Paul Janssens

BACKGROUND: Ventilators designed for home care provide clinicians with built-in software that records items such as compliance, leaks, average tidal volume, total ventilation, and indices of residual apnea and hypopnea. Recent studies have showed, however, an important variability between devices regarding reliability of data provided. In this study, we aimed to compare apnea-hypopnea indices (AHI) provided by home ventilators (AHINIV) versus data scored manually during polysomnography (AHIPSG) in subjects on noninvasive ventilation (NIV) for obesity-hypoventilation syndrome. METHODS: Stable subjects with obesity-hypoventilation syndrome on NIV, all using the same device, underwent 3 consecutive polysomnographic sleep studies with different backup breathing frequencies (spontaneous mode, low and high backup breathing frequencies). During each recording, AHINIV was compared with AHIPSG. RESULTS: Ten subjects (30 polysomnogram tracings) were analyzed. For each backup breathing frequency (spontaneous mode, low and high backup breathing frequencies), AHI values were 62 ± 7/h, 26 ± 7/h, and 17 ± 5/h (mean ± SD), respectively. Correlation between AHINIV and AHIPSG was highly significant (r2 = 0.89, P < .001). As determined by Bland-Altman analysis, mean bias was 6.5 events/h, and limits of agreement were +26.0 and −12.9 events/h. Bias increased significantly with higher AHI values. Using a threshold AHI value of 10/h to define appropriate control of respiratory events, the ventilator software had a sensitivity of 90.9%, a specificity and positive predictive value of 100%, and a negative predictive value of 71%. CONCLUSIONS: In stable subjects with obesity-hypoventilation syndrome, the home ventilator software tested was appropriate for determining if control of respiratory events was satisfactory on NIV or if further testing or adjustment of ventilator settings was required. (ClinicalTrials.gov registration NCT01130090.)


Paediatric Respiratory Reviews | 2016

New modes in non-invasive ventilation.

Claudio Rabec; Guillaume Emeriaud; Alessandro Amadeo; Brigitte Fauroux; Marjolaine Georges

Non-invasive ventilation is useful to treat some forms of respiratory failure. Hence, the number of patients receiving this treatment is steadily increasing. Considerable conceptual and technical progress has been made in the last years by manufacturers concerning this technique. This includes new features committed to improve its effectiveness as well as patient-ventilator interactions. The goal of this review is to deal with latest advances in ventilatory modes and features available for non-invasive ventilation. We present a comprehensive analysis of new modes of ventilator assistance committed to treat respiratory failure (hybrid modes) and central and complex sleep apnea (adaptive servo ventilation), and of new modes of triggering and cycling (neurally adjusted ventilatory assist). Technical aspects, modes of operation and settings of these new features as well as an exhaustive review of published data, their benefits and limits, and the potential place of these devices in clinical practice, are discussed.


European Respiratory Journal | 2014

Can diaphragm pacing improve gas exchange? Insights from quadriplegic patients

Jésus Gonzalez-Bermejo; Capucine Morélot-Panzini; Marjolaine Georges; Alexandre Demoule; Thomas Similowski

To the Editor: Diaphragm pacing, as obtained by phrenic nerve stimulation through implanted electrodes, is a valid alternative to positive pressure mechanical ventilation (PPV) in patients with high spinal cord injuries [1]. Diaphragm pacing allows such patients to be weaned from PPV, but, to date, the respective effects of diaphragm pacing and PPV on gas exchange have not been compared. PPV is known to reduce ventilation in the lung bases [2]. By contrast, diaphragm pacing, like spontaneous breathing, should direct a larger proportion of the inspired volume to the lung bases. This should improve ventilation/perfusion matching. If this is the case, diaphragm pacing could be of interest as an adjunct to PPV in patients with lung injury. Indeed, in this setting, preserving diaphragmatic activity during mechanical ventilation can improve arterial oxygenation [3]. However, this can be difficult to achieve from a comfort point of view. In a proof-of-concept perspective, we compared blood gases and energy expenditure during PPV and diaphragm pacing in 10 quadriplegics. 10 consecutive, stable and well-nourished tracheotomised quadriplegic patients were studied (six males, aged 15–46 years, mean±sd body mass index 21.9±4.0 kg·m−2). All had a phrenic nerve stimulator (Atrostim; Atrotech, Tampere, Finland) implanted at least 6 months earlier and were considered fully reconditioned. They were studied during planned routine visits, after approval of the ethics committee of the French Learned Society for Intensive Care Medicine. All patients gave their informed consent. Measurements were performed at least 3 h after a meal, with the tracheal cuff inflated. Oxygen consumption ( V ′O2), carbon dioxide production ( V ′CO2) and respiratory quotient were …

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P. Camus

University of Burgundy

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P. Bonniaud

University of Burgundy

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Brigitte Fauroux

Necker-Enfants Malades Hospital

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